Dollar stores tend to sell less healthy food, but households that shop there appear to compensate by making healthier purchases elsewhere, a new study suggests.
Researchers from Tufts University in Boston analyzed more than a decade of household food purchasing data from 183,000 U.S. households between 2008 and 2020.
The study, published Monday in the Journal of the Academy of Nutrition and Dietetics, found that dollar stores now account for 6.5% of household calories, double the 3.4% they made up in 2008.
MORE: How dollar store grocery options stack up to traditional stores
To track the healthfulness of household food purchases and diet quality, the team looked at data from the Healthy Eating Index (HEI), which ranges from 0 to 100.
The HEI measures how closely a person's diet aligns with national dietary guidelines, considering factors such as fruit and vegetable intake, whole grains and fat consumption. Higher scores indicate better alignment with these recommendations.
Researchers excluded non-food items like alcohol and tobacco, as well as fresh foods like fruits, vegetables, meats, and seafood, which don't have standard nutrition labels. Meals eaten outside the home, such as those at restaurants, were also not included in the assessment.
Households with substantial purchases at dollar stores had an HEI score of 46.3, which was similar to the 48.2 score of those with moderate purchases and the 50.5 score of those with no purchases.
"Purchases directly from dollar stores were less healthy, but even households that bought a lot from dollar stores had overall diets similar in healthfulness to those who bought less -- suggesting they may be getting healthier options from other places," Dr. Wenhui Feng, a professor of health care policy research at Tufts University School of Medicine and lead author of the study, told ABC News.
Families were likely strategizing by purchasing certain items at dollar stores for affordability, while continuing to buy healthier items at other grocery stores, Feng suggested.
The study also found overall that household diet quality remained consistent long-term, even as the share of food calories from dollar stores doubled.
"Most of what dollar stores sell is likely ultra-processed -- packaged, ready-to-eat foods that tend to be higher in salt and additives that aren't necessarily healthy," Dr. Marie-Pierre St-Onge, a professor of nutritional medicine at the Columbia University Irving Medical Center, who was not involved in the study, told ABC News.
MORE: Dollar Tree and Family Dollar will close 1,000 stores following fourth-quarter loss
St-Onge said this is troubling given the rapid growth of dollar stores, especially in low-income and rural areas. In these areas, dollar stores play a much larger role in food access, sometimes serving as one of the few nearby retail options, she noted.
But St-Onge added that the issue probably won't be solved by simply restricting dollar stores.
"Everyone should have access to affordable, healthful foods no matter where they're sold," she said. "If dollar stores are more prevalent in certain neighborhoods, improving their offerings would be a great step."
Feng stressed that food accessibility is clearly a nuanced issue that requires work beyond just stopping the expansion of dollar stores. Even if the issue of access is solved, he said that nutritional inequality may still exist due to consumer preferences and economic constraints.
"I don't think there is one policy that can make food purchase immediately healthier. We should approach this as part of the greater discussion about food access and food affordability," Feng said.
Veer Patel, MD, is an emergency medicine doctor at Maimonides Medical Center and a member of the ABC News Medical Unit
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